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General NPI Number Information
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NPI Number | 1972011021
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Entity Type | Individual
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Provider Name | SOUICHI WOOD PHARMD
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Gender | Male
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Dates
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Enumeration Date | 01/10/2018
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Last Update Date | 01/10/2018
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Provider Practice Location Address
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Address Line | 1539 NE STEPHENS ST
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City | ROSEBURG
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State | OR
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Zip | 97470-1563
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Country | US
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Telephone | 541-957-2540
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Fax |
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Provider Business Mailing Address
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Address Line | 2541 NW EDENBOWER BLVD APT 113
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City | ROSEBURG
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State | OR
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Zip | 97471-8814
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Country | US
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Telephone | 808-227-7567
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH-0016383
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License Number State | OR
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